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Ann Thorac Surg 1999;67:1065-1069
© 1999 The Society of Thoracic Surgeons

Original Articles

Distribution of cerebral flow using retrograde versus antegrade cerebral perfusion

Michael G. Katz, MD, PhDa, Vadim Khazin, MDb, Adam Steinmetz, MDc, Michael Sverdlov, MDb, Andrew Rabin, MDd, David Chamovitz, MDc, Arie Schachner, MDa, Amram J. Cohen, MDa

a Departments of Cardiovascular Surgery, Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
b Anesthesiology, Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
c Nuclear Medicine Institute, Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
d Angiology Unit, Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

Accepted for publication September 29, 1998.

Address reprint requests to Dr Cohen, Department of Cardiovascular Surgery, Wolfson Medical Center, Holon 58100 Israel

Background. This study compared flow to the brain with retrograde and antegrade cerebral perfusion during circulatory arrest.

Methods. Twenty-four rabbits were injected with 5 mCi of technetium-99 macroaggregated albumin, a tracer trapped in the capillaries. Group I (n = 6) were maintained normothermic, and the tracer was injected into the ascending aorta. Group II (n = 6) were maintained normothermic, and underwent cannulation of the superior vena cava (SVC), exsanguination through the aorta, and injection of the tracer into the SVC, which was proximally occluded. In group III (n = 6), the animal was cooled to 25°C. The animal was exsanguinated through the aorta and tracer was injected into the ascending aorta. In group IV (n = 6), animals were cooled to 25°C. The animal was exsanguinated through the ascending aorta and tracer was injected into the SVC. Three animals (group V) were exsanguinated through the ascending aorta and a retrograde venogram of the SVC was performed. Scintigraphy of groups I to IV was carried out on a digital gamma camera. Brain trapping of tracer was graded from 0 to 5, with 0 being no tracer in the brain and 5 being dominant tracer trapping in the brain.

Results. Tracer trapping in the brain showed group I, 3.67 ± 0.82; group II, 0; group III, 4.67 ± 0.41; group IV, 0.17 ± 0.41 (p < 0.0001). Retrograde venogram of the SVC showed flow into the cerebral veins.

Conclusions. Retrograde flow through the SVC reaches the cerebral venous system. Flow arriving in retrograde fashion does not go through the capillary system.


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